LEHNE’S PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSES AND

PHYSICIAN ASSISTANTS 2ND EDITION ROSENTHAL TEST BANK

Chapter 1 Prescriptive Authority

Chapter 2 Rational Drug Selection and Prescription Writing

Chapter 3 Promoting Positive Outcomes of Drug Therapy

Chapter 4 Pharmacokinetics, Pharmacodynamics, and Drug Interactions

Chapter 5 Adverse Drug Reactions and Medication Errors

Chapter 6 Individual Variation in Drug Responses

Chapter 7 Genetic and Genomic Considerations in Pharmacotherapeutics

Chapter 8 Drug Therapy During Pregnancy and Breast-Feeding

Chapter 9 Drug Therapy in Pediatric Patients

Chapter 10 Drug Therapy in Geriatric Patients

Chapter 11 Basic Principles of Neuropharmacology

Chapter 12 Physiology of the Peripheral Nervous System

Chapter 13 Muscarinic Agonists

Chapter 14 Muscarinic Antagonists

Chapter 15 Adrenergic Agonists

Chapter 16 Adrenergic Antagonists

Chapter 17 Indirect-Acting Antiadrenergic Agents

Chapter 18 Introduction to Central Nervous System Pharmacology

Chapter 19 Drugs for Parkinson Disease

Chapter 20 Drugs for Alzheimer Disease

Chapter 21 Drugs for Seizure Disorders

Chapter 22 Drugs for Muscle Spasm and Spasticity

Chapter 23 Local Anesthetics

Chapter 24 Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics

Chapter 25 Drugs for Headache

Chapter 26 Antipsychotic Agents and Their Use in Schizophrenia

Chapter 27 Antidepressants

Chapter 28 Drugs for Bipolar Disorder

Chapter 29 Sedative-Hypnotic Drugs

Chapter 30 Management of Anxiety Disorders

Chapter 31 Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder

Chapter 32 Substance Use Disorders I: Basic Considerations

Chapter 33 Substance Use Disorders II: Alcohol

Chapter 34 Substance Use Disorders III: Nicotine and Smoking

Chapter 35 Substance Use Disorders IV: Major Drugs of Abuse Other Than Alcohol and Nicotine

Chapter 36 Review of Hemodynamics 37. Diuretics 38. Drugs Acting on the Renin-Angiotensin-Aldosterone System

Chapter 39 Calcium Channel Blockers

Chapter 40 Vasodilators

Chapter 41 Drugs for Hypertension

Chapter 42 Drugs for Heart Failure

Chapter 43 Antidysrhythmic Drugs

Chapter 44 Prophylaxis Atherosclerotic Cardiovascular Disease: Drugs Cholesterol TriglycerideLevels

Chapter 45 Drugs for Angina Pectoris

Chapter 46 Anticoagulant, Antiplatelet, and Thrombolytic Drugs

Chapter 47 Drugs for Deficiency Anemias

Chapter 48 Drugs for Diabetes Mellitus

Chapter 49 Drugs for Thyroid Disorders

Chapter 50 Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications

Chapter 51 Birth Control

Chapter 52 Androgens

Chapter 53 Drugs for Erectile Dysfunction and Benign Prostatic Hyperplasia

Chapter 54 Review of the Immune System

Chapter 55 Childhood Immunization

Chapter 56 Antihistamines

Chapter 57 Cyclooxygenase Inhibitors: Nonsteroidal Anti-inflammatory Drugs and Acetaminophen

Chapter 58 Glucocorticoids in Nonendocrine Disorders 59. Drug Therapy of Rheumatoid Arthritis

Chapter 60 Drug Therapy of Gout 61. Drugs Affecting CalciumLevels and Bone Mineralization

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Chapter 62 Drugs for Asthma and Chronic Obstructive Pulmonary Disease

Chapter 63 Drugs for Allergic Rhinitis, Cough, and Colds

Chapter 64 Drugs for Peptic Ulcer Disease

Chapter 65 Laxatives

Chapter 66 Other Gastrointestinal Drugs

Chapter 67 Vitamins

Chapter 68 Drugs for Weight Loss

Chapter 69 Complementary and Alternative Therapies

Chapter 70 Basic Principles of Antimicrobial Therapy

Chapter 71 Drugsthat Weaken the Bacterial Cell Wall I: Penicillins

Chapter 72 Drugsthat Weaken the Bacterial Cell Wall II: Other Drugs

Chapter 73 Bacteriostatic Inhibitors of Protein Synthesis

Chapter 74 Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis

Chapter 75 Sulfonamides and Trimethoprim

Chapter 76 Drug Therapy of Urinary Tract Infections

Chapter 77 Drugs Therapy for Tuberculosis

Chapter 78 Miscellaneous Antibacterial Drugs

Chapter 79 Antifungal Agents 80. Antiviral Agents I: Drugs for Non-HIV Viral Infections

Chapter 81 Antiviral Agents II: Drugs for HIV Infection and Related Opportunistic Infections

Chapter 82 Drug Therapy of Sexually Transmitted Diseases

Chapter 83 Anthelmintics, Antiprotozoal Drugs, and Ectoparasiticides

Chapter 84 Introduction to Immunomodulators

Chapter 85 Supportive Care of Patients Receiving Anticancer Drugs

Chapter 86 Drugs for Cancer Pain

Chapter 87 Drugs for the Eye

Chapter 88 Drugs for the Skin

Chapter 89 Drugs for the Ear

Chapter 90 Agents Affecting the Volume and Ion Content of Body Fluids

Chapter 91 Management of ST-Elevation Myocardial Infarction

Chapter 92 Additional Acute Care Drugs

Chapter 1: Prescriptive Authority

Test Bank

Multiple Choice

1. An APRN works in a urology clinic under the supervision of a physician who does not restrict

the types of medications the APRN is allowed to prescribe. State law does not require the

APRN to practice under physician supervision. How would the APRN’s prescriptive authority

be described?

a. Full authority

b. Independent

c. Without limitation

d. Limited authority

ANS: B

The APRN has independent prescriptive authority because the regulating body does not

requirethat the APRN work under physician supervision. Full prescriptive authority gives the

provider the right to prescribe independently and without limitation. Limited authority places

restrictions on the types of drugsthat can be prescribed.DIF: CognitiveLevel:

ComprehensionREF: p. 1TOP: Nursing Process: IMSC: NCLEX Client Needs Category:

Physiologic Integrity: Pharmacologic and Parenteral Therapies

2. Which factors increase the need for APRNs to have full prescriptive authority?

a. More patients will have access to health care.

b. Enrollment in medical schools is predicted to decrease.

c. Physician’s assistants are being utilized less often.

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d. APRN education is more complex than education for physicians.

ANS: A

Implementation of the Affordable Care Act has increased the number of individuals with health

care coverage, and thus the number who have access to health care services. The increase in the

number of patients createsthe need for more providers with prescriptive authority. APRNs can fill

this practice gap.DIF: Cognitive Level: ComprehensionREF: p. 2TOP: Nursing Process:

Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic

andParenteral Therapies

3. Which factors could be attributed to limited prescriptive authority for APRNs?

Select allthat apply.

a. Inaccessibility of patient care

b. Higher health care costs

c. Higher quality medical treatment

d. Improved collaborative care

e. Enhanced health literacy

ANS: A , B

Limiting prescriptive authority for APRNs can create barriers to quality, affordable, and accessible

patient care. It may also lead to poor collaboration among providers and higher health care costs.

It would not directly impact patient’s health literacy.DIF: CognitiveLevel:ComprehensionREF:

p. 2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic

Integrity: Pharmacologic and Parenteral Therapies

4. Which aspects support the APRN’s provision for full prescriptive authority?

Select allthat apply.

a. Clinical education includes prescription of medications and diseaseProcesses.

b. Federal regulations support the provision of full authority for APRNs.

c. National examinations provide validation of the APRN’s ability to provide safecare.

d. Licensure ensures compliance with health care and safety standards.

e. Limiting provision can decrease health care affordability.

ANS: A , C , D

APRNs are educated to practice and prescribe independently without supervision. National

examinations validate the ability to provide safe and competent care. Licensure ensures

compliance with standards to promote public health and safety. Limited prescriptive authority

creates numerous barriers to quality, affordable, and accessible patient care.DIF: CognitiveLevel:

ComprehensionREF: pp. 1-2TOP: Nursing Process: ImplementationMSC: NCLEX Client Needs

Category: Physiologic Integrity: Pharmacologic andParenteral Therapies

5. Which aspects support the APRN’s provision for full prescriptive authority?

Select allthat apply.

a. Clinical education includes prescription of medications and diseaseProcesses.

b. Federal regulations support the provision of full authority for APRNs.

c. National examinations provide validation of the APRN’s ability to provide safecare.

d. Licensure ensures compliance with health care and safety standards.

ANS: A , C , D

APRNs are educated to practice and prescribe independently without supervision. National

examinations validate the ability to provide safe and competent care. Licensure ensures

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compliance with standards to promote public health and safety. Limited prescriptive authority

creates numerous barriersto quality, affordable, and accessible patient care.DIF: CognitiveLevel:

ComprehensionREF: pp. 1-2TOP: Nursing P r o c e s s : ImplementationMSC: NCLEX

Client Needs Category: Physiologic Integrity: Pharmacologic andParenteral Therapies

6. A family nurse practitioner practicing in Maine is hired at a practice across state lines in

Virginia.Which aspect of practice may change for the APRN?

a. The APRN will have less prescriptive authority in the new position.

b. The APRN will have more prescriptive authority in the new position.

c. The APRN will have equal prescriptive authority in the newposition.

d. The APRN’s authority will depend on federalregulations.

ANS: A

Virginia allows limited prescriptive authority, while Maine gives full authority to certified nurse

practitioners. The federal government does not regulate prescriptive authority.DIF:

CognitiveLevel: ComprehensionREF: p. 3TOP: NursingProcess: Implementation MSC: NCLEX

Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Providers, 2nd Ed.

Chapter 2: Rational Drug Selection and Prescription Writing

Test Bank

Multiple Choice

7. How can collaboration with a pharmacist improve positive outcomes for patients?

Select allthat apply.

a. Pharmacists can suggest foodsthat will help with the patient’s condition.

b. Pharmacists have additional information on drug interactions.

c. The pharmacist can suggest adequate medication dosing.

d. Pharmacists have firsthand knowledge of the facility formulary.

e. Pharmacy can alter prescriptions when necessary to prevent patient harm.

ANS: B , C , D

Providersshould collaborate with pharmacists because they will likely have additional information

on formulary, drug interactions, and suggestions for adequate medication dosing. Dietitians can

make foods recommendations to treat the patient’s condition. The pharmacist can contact the

prescriber about questionable prescriptions, but cannot alter the prescription without notification

of and approval by the provider.DIF: CognitiveLevel: ComprehensionREF: p. 9TOP:

NursingProcess: DiagnosisMSC: NCLEXClient Needs Category: Physiologic Integrity:

Reduction ofRisk Potential

8. Apatient presents with deliriumtremensrequiring Ativan administration. The provider ofcare

is not in the facility.Which action by the nurse is most appropriate?

a. Obtain a telephone order.

b. Contact the on-call hospitalist.

c. Obtain an order from the chargenurse.

d. Wait for a written Ativan order.

ANS: A

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In an emergency situation, such as deliriumtremens with seizure activity, it is acceptable to provide

a telephone order. Contacting the on-call hospitalist or waiting for a written order would take more

time than available for a patient with high seizureRisk. Writing an order is outside the scope of

practice for the charge nurse.DIF: CognitiveLevel: ApplicationREF: p. 7TOP: NursingProcess:

ImplementationMSC: NCLEXClient Needs Category: Physiologic Integrity: Reduction ofRisk

Potential

9. A patient with chronic pain calls the provider’s office to request a refill on their

oxycontin.Which action is most appropriate?

a. Fax an order to the pharmacy.

b. Schedule an appointment with the patient.

c. Verify the patient’s adherence to drug regimen.

d. Determine the patient’s current medication dosage.

ANS: B

Schedule II medications are not eligible for refills, and prescriptions must be handwritten. It is

important to verify the patient’s adherence to the drug regimen and determine the current dosage

of medication; however, this can be accomplished by scheduling an appointment and evaluating

the patient in person.DIF: CognitiveLevel: ApplicationREF: p. 8TOP: NursingProcess:

ImplementationMSC: NCLEXClient Needs Category: Physiologic Integrity: Reduction ofRisk

Potential

10. Apatient prescribed amoxicillin for streptococcal pharyngitisreports new onset of a flat, itchy

red rash on the chest and neck.Which action is most important?

a. Provide a different prescription.

b. Discontinue the medication.

c. Prescribe an antihistamine cream.

d. Assess for respiratory compromise.

ANS: B

The priority action is to discontinue the medication to prevent worsening of the patient’s

symptoms. A different prescription would be provided, topical antihistamine may be administered,

and the patient would be assessed for respiratory involvement, but these actions would not be

performed first.DIF: CognitiveLevel: ApplicationREF: p. 6TOP: NursingProcess:

ImplementationMSC: NCLEXClient Needs Category: Physiologic Integrity: Reduction ofRisk

Potential

11. A patient taking three medications for hypertension is diagnosed with COPD.Which action

should be taken prior to prescribing medications to treat COPD?

a. Obtain baseline laboratory values.

b. Obtain a complete medication history.

c. Assess liver enzymeL e v e ls.

d. Determine if patient has insurance coverage.

ANS: B

Prior to adding medications to the treatment regimen, it is essential to assess for any potential drugdrug interactions through a complete medical history. Baseline laboratory values are not necessary

for COPD treatment. Liver enzymeLevels may give insight into the possibility of altered

metabolism but would not be the first action. The presence of insurance coverage would affect the

patient’s access to treatment but may not affect the type of medication prescribed.DIF:

 5 / 6

CognitiveLevel: ApplicationREF: p. 6TOP: NursingProcess: ImplementationMSC:

NCLEXClient Needs Category: Physiologic Integrity: Reduction ofRisk Potential

12. A patient with diabetes reports losing their job and an inability to purchase required

medications.Which action is most appropriate?

a. Provide a 7-day sample pack.

b. Decrease the daily dose by half.

c. Contact a different pharmacy.

d. Prescribe a different medication.

ANS: C

Providing a 7-day sample will address the patient’s immediate need, but will not help with the

patient’s long-term need for medication. Decreasing the daily dose will diminish the effectiveness

of the medication. Selecting a different pharmacy could decrease the cost of the medication, as

costs vary based on the location and the pharmacy dispensing the medication. Prescribing a

different medication would be the last option.DIF: CognitiveLevel: ApplicationREF: p. 5TOP:

NursingProcess: ImplementationMSC: NCLEXClient Needs Category: Physiologic Integrity:

Reduction ofRisk Potential

13. Apatient recently prescribed hydrocodone callsto reporttheyare unable to fillthe

prescription.Which factors could contribute to the inability to fill the prescription?

Select allthat apply.

a. DEA number missing from prescription

b. Prescription sent via electronic messenger

c. Dose higher than typically prescribed

d. Prescriber license number not included

e. Patient name and date of birth were handwritten

ANS: A , B , D

In order to fill a hydrocodone prescription, the prescriber name, license number, DEA number, and

contact information must be included. Schedule II medications, such as narcotics, must be

prescribed using written prescriptions. Though the pharmacist may question the high dosing,that

would not prevent filling the prescription. The patient’s name and date of birth must be included

on the prescription, but there are no regulationsthat the name cannot be handwritten.DIF:

CognitiveLevel: ComprehensionREF: pp. 6-8TOP: NursingProcess: DiagnosisMSC:

NCLEXClient Needs Category: Physiologic Integrity: Reduction ofRisk Potential

Rosenthal: Lehne's Pharmacotherapeutics for Advanced Practice Providers, 2nd Ed.

Chapter 3: Promoting Positive Outcomes of Drug Therapy

Test Bank

Multiple Choice

14. Apatient reportsthata medication prescribed for recurrent migraine headaches isnot

working.Which action should be taken first?

a. Ask the patient about the number and frequency of tablets taken.

b. Assess the patient’s headache pain on a scale from 1 to 10.

c. Report the patient’s complaint to the prescriber.

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